Abstract
Surrogacy continues to be practiced to address infertility in the Philippines; however, discussions on the method are sparse, given its limited accessibility and morally questionable procedures that may concern potential parents in a developing country. Using discourse analysis, the researchers interviewed ten (10) Filipino Roman Catholics who were struggling with infertility, to uncover how they construct the idea of surrogacy. The study shows the discourses on surrogacy are often approached in a detached manner, where potential parents describe the method as a last choice or one that is never considered. They articulate this position by highlighting the emotional factors surrogacy would entail; the women, in particular, described the involvement of another individual as “taking over” the role of the mother. Participants placed themselves in positions of both power and vulnerability, reconciling the split between surrogacy as a compassionate act or a transactional business. The ambiguous role of faith was also negotiated by the participants, where they argued for surrogacy using alternative teachings or through God-given “free will”. The discourses present considerations for the continued practice of surrogacy among key players in reproductive health in developing countries, recognizing the concerns of infertile couples to enable informed decision-making and policy creation.
Surrogacy is a radical way of addressing the problem of infertility, which may be contentious in a conservative third-world nation like the Philippines. According to a senate bill drafted to prohibit it, surrogacy is defined as the process where a fertile woman “agrees to conceive a child naturally or artificially, by her own lawful husband or otherwise, for the purpose of giving that child away after birth, or while already conceiving shall agree to give away the child after birth, to another person with the intention of giving up permanently all her paternal rights, love and affection over the child” (S. 2344, 2006, p.1). The idea is not entirely new, as it has been represented in the public eye through various Filipino films, and popularized by local celebrities in recent years. Surrogacy continues to be practiced in the Philippines with the presence of clinics and agencies that connect Filipinos, whether as commissioning parents or surrogate mothers, to relevant parties. They often take a transnational arrangement, wherein couples from developed countries in the West outsource mothers from many developing countries in Asia, including the Philippines, where surrogacy is viewed to be “flexible” due to the cheaper costs and limited laws to govern it (Aguiling-Pangalangan, 2019). Despite its prevalence, surrogacy remains to be secretive and unexplored among most Filipinos, due to the concerns about its nonconformity to the current Catholic and conservative belief system dominating Philippine society (Pangalangan, Dawana, Kibanoff, & Ramos, 2017).
The current study hopes to address the gap between the limited discussion of surrogacy and its continued practice in the Philippines by exploring the discourses on surrogacy among Filipino infertile couples. It hopes to advance existing literature on surrogacy by focusing on the dominant discourses on potential parents (Ciccarelli & Beckman, 2005; van den Akker, 2007), who ultimately drive the demand for the service. This provides a new perspective to existing studies mainly focusing on commissioning parents who availed of surrogacy in Western developed countries (Majumdar, 2014; Markens, 2012; Millbank, 2012). The Philippines is an interesting case, where there are large gaps between social classes further emphasized in the surrogacy arrangement, and the Church’s undeniable influence over reproductive policies in the country (Genilo, 2014). Through a discursive analysis framework, the research examines how participants construct their ideas on the method, supporting or contesting the existing discourses on surrogacy, which may inform guidelines to protect everybody in the process (Aguiling-Pangalangan, 2019; Tehran, Jafarbagloo, Sheikholeslami, Abedini, & Heidarpoor, 2010).
Discourses on surrogacy
Discourses on surrogacy typically highlight two contrasting narratives: opportunity and choice versus exploitation and inequality (Millbank, 2012). This is consistent in both public discourses and scientific literature on surrogacy. The prevalent views may consequently influence the discourses of potential commissioning parents on the method.
Public discourses
The media serves as a primary source of information for many potential parents (Markens, 2012; Arvidsson, Johnsdotter, & Essén, 2015), cultivating their attitudes and normative understandings on the process (Ventura, Rodríguez-Polo, & Roca-Cuberes, 2018; Riggs & Due, 2012). Surrogacy is framed depending on its intended purpose to “discursively construct and debate the international surrogacy market” (p. 1745) in favor of a particular view (Markens, 2012). This is evident in differential framings based on the audience of various newspapers (van den Akker, Fronek, Blyth, & Frith, 2015), and overall shifts in framing depending on the historical and political contexts in which it is published (Millbank, 2012). Western media has highlighted different facets of surrogacy, including positive aspects such as how it may serve as a “cure” to infertility and give opportunities to help uplift the lives of disadvantaged women (Millbank, 2012; Markens, 2012). It has also focused on its limitations, including how it is only accessible to those who can afford it, as well as the need to navigate legal boundaries (van den Akker, Fronek, Blyth, & Frith, 2015). Given its disruption of the traditional methods of childbearing, there are many discourses about who the “real” parents of the child are, and the corresponding stigma on those who choose to engage in it (Millbank, 2012; van den Akker, Fronek, Blyth, & Frith, 2015). These discourses extend to the East, with Madumjar (2013) pointing out such discourses are “selective and exclusionary”, as they fail to amplify the voices of the surrogate mothers in favor of continuing the dominant discussions in the West.
Scientific literature
Studies in the literature highlight the two frames of reference under appropriate theoretical frameworks. A commonly used lens is one of feminism, which has conflicting views of empowerment and desperation (Arvidsson, Vauquline, Johnsdotter, & Essén, 2017). Although surrogacy can be viewed as a way to empower women to exercise control over their chosen reproductive mode, surrogate mothers potentially risk becoming “breeding machines” when practiced without limitations (Andrews, 1988). Majumdar (2014) describes three predominant discourses that arise when taking a feminist lens regarding commercial surrogacy, which includes the commodification of “motherhood”, the “romance” of the gift relationship, and the “agency” of the surrogate mother.
The dynamics of power are further emphasized when viewing surrogacy under a postcolonial lens, rendering it as another instance of imperialism or cultural colonization given the systemically orientalist set up typically between India and the West (Lau, 2018). Schurr and Militz (2018) argue commodification always takes place, regardless of how it is framed, because surrogacy delineates the intimate boundaries of families through the processes of attachment and detachment. Thus, to justify the aspect of choice in their participation, market actors may utilize moral frames of compassion and altruism, emphasizing how surrogacy can empower disadvantaged women to further their reproductive rights (Rudrappa & Collins, 2015). Khader (2013) suggests gender, race, and class oppression, which is often imagined to subject women to more harm, can instead “mitigate the negative welfare effects of being a commercial surrogate” (p.69), claiming they are less likely to be taken advantage of and are more likely to acquire significant financial benefits when compared to their Western counterparts.
Discourses of commissioning parents
In light of the existing discourses, surrogacy is often viewed as a last resort for many infertile couples because it is perceived as a “difficult” process to engage in (Arvidsson et al., 2015). It may be framed as an arrangement victimizing both potential parents and surrogate mothers (Deomampo, 2013), taking advantage of the parents’ “reproductive vulnerability” (Riggs & Due, 2012). Despite this, commissioning parents and providers of services are more likely to be regarded in positions of power in the arrangement (Sandoval, 2010), contributing to the potentialization of the surrogate mother’s body (Vora, 2013). Even if both are vulnerable, the extent to which they are affected differs (Pantich, 2013). Macer (2014) points out this gap is even wider in the case of transnational surrogacy, as additional factors may contribute to wider disparities among the parties. Commissioning parents are positioned as agentic citizens with the power to undertake reproductive travel (Riggs & Due, 2012).
As a result, Western commissioning parents who have availed of the service communicate their personal duty for their fertility, situated within an “individualist rhetoric of choice” (Madsen, 2014). This is in line with a neo-liberal ideological perspective, which promotes the idea that infertile individuals take “personal responsibility” for their fertility, consequently making decisions to maximize their chances of pregnancy and turning particular reproductive matters into commodities (Kroløkke & Pant, 2012, p.234). In effect, commissioning parents’ discourses involve trying to negotiate the ambiguous ideas they have about surrogacy by defying the exploitation discourse, while holding uncertainty if they are also perpetuating it by engaging in surrogacy (Arvidsson et al., 2015). They may utilize the rhetoric of “global sisterhood” to emphasize the struggle of the intended mothers and sensationalize the experiences of the surrogate mothers in India; ultimately, they position surrogacy as a solution to injustice, rather than a symptom of it (Fixmer-Oraiz, 2013).
Discourses in the Philippines
The academic discourses on surrogacy in the Philippines are limited. There has been one study (Pangalangan et al., 2017) that looks at different perspectives on surrogacy among Filipinos involved in the process, leaving out potential parents. It revealed surrogacy as a largely unexplored practice in the Philippines, attributed to the risks involved, such as emotional attachment among the mothers, financial scamming on the part of the agent, perception of risk in the child’s future among the general population, and the strict rules set in place by the agencies to mitigate these problems (Pangalangan et al., 2017). There is also a lack of legal parameters when dealing with surrogacy, which serves as both a reason why many avail of it in the Philippines compared to other countries, and a deterrent due to the unclear consequences of doing so (Guidote, 2017; Aguiling-Pangalangan, 2019). All of this gives surrogacy its secretive nature in the Philippines, further enforced by conservative culture, which may hinder key players from discussing the issue in public spaces (Pangalangan et al., 2017).
The current study
Existing studies have tackled transnational discourses on surrogacy focused on developed countries, failing to consider the unique contextual factors that may influence decision-making of those in other nations. Potential parents in developing countries are overlooked, since such countries usually provide, rather than avail of, the service. Moreover, existing research focuses primarily on commissioning couples who have ultimately availed of surrogacy, with little consideration of how they have come to the decision to do so.
The researchers aim to address the gaps mentioned by looking into the construction and implications of the discourses among Filipino men and women who are currently struggling with infertility. Thus, the researchers used discourse analysis to examine the discussions among potential parents on surrogacy in the Philippines, answering the inquiry: What are the discourses on surrogacy among Filipinos who have struggled with infertility? The discursive approach can reveal how potential parents use their existing resources to construct the issue, which affects and is affected by the context of the issue and the country.
Theoretical framework
Discourse analysis is an appropriate framework to examine the data, as it shows how surrogacy is actively constructed by the participants, rather than simply reflecting an inner reality that can be difficult to access (Potter & Wetherell, 1987, p.6). It highlights the importance of language and its action orientation, which enables participants to conceptualize their reality through its constructive and functional purposes (Willig, 2008). Discourse analysis can show how they utilize pre-existing linguistic resources, active selection, and the potent and consequential nature of accounts to achieve particular goals, whether intentional or otherwise (Potter & Wetherell, 1987, p.34). It allows participants to describe the phenomenon in their own terms, capturing the varying discourses that may occur. Given the sensitive and controversial nature of surrogacy, a discourse analysis can tackle the subject on the terms of the participants. The manner in which they discuss the subject may have implications on the decisions potential parents take in regard to childbearing, and can contribute toward the wider range of discourses ultimately framing surrogacy in the Philippines.
Method
The study adopted a qualitative approach using semi-structured interviews to examine how individuals construct the issue of surrogacy in light of their experiences with infertility.
Participants
The study examined the discourses of 10 Filipinos, including six women and four men, who were dealing with primary infertility, which means they have not had any children in the past. Infertility was defined as the “absence of a live birth for couples who desire a child”, after at least 12 months or more of regular sexual intercourse without any contraceptives, regardless of any other medical conditions (Mascarenhas et al., 2012, p.3; Zegers-Hoschschild et al., 2009). They are referred to as the “potential parents” throughout the study, who have yet to commission surrogacy services. The participants were all practicing Roman Catholics from Metro Manila, who fit a range of socioeconomic classes (middle-upper brackets). All individuals were currently trying to have children with their partner, with some previously having unsuccessful pregnancies. All reported visiting fertility clinics and taking medications to help them conceive.
Procedures
Recruitment
The sample was acquired through voluntary response sampling. A flyer was posted through social media platforms in order to recruit participants who were then contacted by the researchers.
Interviews
All interviews took place in convenient locations for the interviewees in Metro Manila, Philippines in 2019. A semi-structured interview was conducted following an interview schedule. Participants were given copies of a consent form to read and sign. Different childbearing methods were discussed in the interview proper, including their knowledge, hesitations, and personal considerations about each. Surrogacy was later introduced among these options. A formal definition of surrogacy was provided (“surrogacy is the practice wherein a woman carries a child for another individual or couple with the intention that the child should be handed over to them after birth”) after participants shared their own construction, to provide information for those who had little to no knowledge on the method to enable the conversation to move forward. This was followed by questions about their perspectives and considerations on the procedure. To guide the discussion, the various aspects of surrogacy were mentioned, such as the perceptions on the key players (surrogate mothers, potential parents, agencies) and potential concerns (financial, legal, ethical, religious, social), depending on the direction of the participants’ conversation. The interview concluded by asking them what their present stand on surrogacy is.
Ethical protocols
Necessary precautions throughout the study were taken to ensure anonymity and confidentiality of the participants. A signed consent was obtained from the participants before the interview. Code names were given to each participant. Any data acquired was used solely for the purposes of the study. Precautions were also taken to minimize harm among participants given the sensitive nature of the topic: the interviewees were briefed about the topics to be discussed before the interview, and questions were strategically focused on their conceptualization and opinion on surrogacy. Personal questions were limited, unless initiated by the respondent.
Data analysis procedures
The current study used Potter and Wetherell’s Discourse Analysis in Social Psychology (1987) framework in interpreting the data. The researchers started with transcribing the interviews and creating codes for each one, noting passages that were perceived to be significant in relation to the research question (p. 167). The first phase of analysis consisted of looking for patterns and intertextuality in the discursive content, highlighting both variability and consistency within and among accounts (p. 168). The researchers found similar subjects discussed among the participants (e.g., the role of faith) and examined how their discourses varied (e.g., faith playing a prominent or insignificant role). The second phase emphasized the function and consequences of their constructions (p. 168). The researchers attended to the context by which specific ideas are said within the discussion, as well as the forms in which they were delivered (e.g., stylistic features, figures of speech, categories, forms of argument, etc.). The effects of the discourses were interpreted by the researchers to provide explanation for the patterns found (p. 169). To validate the findings, the researchers engaged in intercoding to ensure the analysis was coherent, and returned to the transcripts to confirm each orientation was adequately reflected (p.170).
Results and discussion
Four distinct discourses on surrogacy were created to highlight the discursive content and practices utilized among infertile couples, where participants utilized their personal experiences of infertility (Johnson & Johnson, 2009), and selective knowledge from the public sphere (Markens, 2012) to support their claims.
Surrogacy as the last choice
Surrogacy was consistently cited as a last choice among the participants, articulated in the impersonal manner in which they discuss the method. When asked to rank childbearing options, surrogacy was least likely to be chosen, in line with literature on surrogacy as a “last resort” for commissioning parents who ultimately availed of the service (Arvidsson et al., 2015). Instead, the alternatives could provide unique benefits like prenatal fetal bonding (as in IVF) (Barlow, 2016), or were not considered to differ much from surrogacy (as in adoption) (Bello, Akinajo, & Olayemi, 2014).
Participants listed factors that made it less likely for them to consider it, including practical considerations, such as the expensive costs and the limited accessibility of the method. These were further enhanced by the possibilities of the method not being successful, with Tracy claiming there would be financial and emotional investments wasted if it was unsuccessful. Ross describes this dynamic: It’s a bigger frustration if you spend so much, than getting frustrated because it doesn’t work. Because if you work for it, you expect it to… you want a positive outcome. Especially if there’s a monetary thing behind it. It’s like… this has to work. You’ll definitely get frustrated if it doesn’t happen.
Although the societal stigma was recognized, it was not given the same priority as personal concerns in the dialogue, contrary to the researchers' assumption that the stigma surrounding infertility in a child-centered country such as the Philippines (Medina, 2001) may significantly influence their decision. It is instead a decision they make on their own as a couple, where the potential parents adapt the Western commissioning parents’ “individualist rhetoric of choice” (Madsen, 2014) over the collectivist mindset in the Philippines.
The degree of consideration varied among the potential parents, despite participants sharing a similar position. While Tracy mentions she is willing to take it if she has “tried everything and it still didn’t work”, other participants do not express intentions of ever considering it, consistently using words like “never” or “I don’t” in their discussion. Participants across all interviews claimed their non-consideration was because of their unfamiliarity with the method. The lack of knowledge was a disclaimer frequently made by the participants, suggesting discourses are limited in reality. They pointed out medical practitioners never mentioned it as an option, and instead contributed their existing knowledge of the method to examples of rich celebrities who have availed of it. In doing so, they effectively distanced themselves from the method, suggesting it was not something they could relate to.
Their consideration of surrogacy as a last choice was manifested in the impersonal manner by which couples discussed surrogacy, utilizing a detached approach. Interviewees frequently referred to people who would consider surrogacy when asked about the issue. This served as an act of disassociation from others who availed of it, which could be seen in Ross’ statement: “If they want it, then they do it. [As long as it’s you,] it’s okay. I’m not for it.” Many participants constantly claimed they did not hold judgement towards those who did avail of it, despite having different decisions on the matter. To do this, they recognized the act of “desperation” commissioning parents take to have a child (Tracy). James remarked “at least they have a kid”, recognizing the end result of surrogacy still brought about the desirable outcome of having a child, something that is described with utmost importance for potential parents trying to conceive. Thus, interviewees still describe other infertile couples as similar to them in terms of struggle and desire to have children, but tend to disassociate when it comes to ways to resolve the problem. The detachment toward the process may be viewed as a way for the infertile individuals to protect themselves from the frustration that comes with the commitment to have a child, given the numerous cycles of despair they would have to go through (Gold, 2013). As a result, they may set reasonable expectations about the methods they would engage in, due to their constant failures at their attempts to conceive.
Surrogate mother “taking over” the surrogate mother’s job
The unique arrangement of surrogacy involves the disruption of women’s key roles in fertility arrangements, resulting in additional burdens to the potential parents. Women are generally positioned to take a significant role in matters of fertility. James explicitly argues for the idea that “surrogacy is the wife’s problem” as he constructs his own situation as an exception to this rule, due to his low sperm count. His statement comes with the assumption that a couple would only avail of a surrogate mother’s services to address the woman’s infertility problems. The differences between the roles of men and women are emphasized in the actions mentioned by the participants to address infertility, where interventions (e.g. pills and injections) were taken primarily by women. There are also differences in the ways they describe their role in the dialogue: Women referred primarily to themselves in making decisions through the pronoun “I”, while men always included their wives in the discussion, utilizing the pronoun “we”, even if the questions were focused solely on their opinion. This can be seen when comparing the similar statement of Ted’ (“if we have used up or we have tried all our options”) to Tracy (“if I’ve tried everything and it still didn’t work”). These observations are in line with findings that frame reproduction as primarily a concern of women (Ciccarelli & Beckman, 2005), where women are more heavily involved in the process of surrogacy as compared to their male partners (MacCallum, Lycett, Murray, Jadva, & Golombok, 2003). As a result, the responsibility of bearing a child often falls on the woman. Nadine mentions she has a “duty for procreation”, a choice of words indicating how seriously she takes this decision.
Surrogacy, then, further disrupts their preconceived notions of a woman’s role in the family, as she is traditionally credited for her domestic ability to bear and care for children (Alcantara, 1994). It is regarded as a difficult process, because it involves giving this special responsibility to another person. Though surrogacy involves taking away the pressure of carrying one’s own child, Lia mentions it would bear an additional burden, because it involves seeing someone else “doing the job” for her, a situation that she constructs as taking a major toll on herself beyond just her initial struggle. This is a sentiment shared with other women as well; Nadine describes a similar situation, where she uses a similar term, “taking over”, in the changed dynamics.
The involvement of another person in their childbearing journey was expressed to be a concern of many participants, particularly due to the attachment between the surrogate mother and child. Several participants noted that the physical connection between the two may cause problems, with Josh mentioning the “the DNA will be messed up”. This can also take away the initial benefits of having one’s own child that surrogacy offered; James talks about how the “umbilical cord” presupposes a connection that influences the child not being their own, while Lia points out the child is “not a part of me anymore”. Worries about emotional attachment between the two is also expressed, as Tracy mentions there is a “bond” that exists between the surrogate and the child, and James acknowledges a “missing link” which points towards the relationship between the potential mother and child as lacking. These concerns are in line with actual concerns of surrogate mothers that focus on psychological and emotional risks of carrying a child (Pangalangan et al., 2017).
As a result, the potential mother may harbor feelings of insecurity about the potential bond between the surrogate and child, a common concern among commissioning parents (Zandi, Vanaki, Shiva, & Mohammadi, 2018). Tracy describes her potential experience, by saying “I know I didn’t give birth to the child [but I might get] postpartum ’cause [I will be] very insecure [that they have a bond], and I won’t.” Ted describes feelings of “pity” toward the surrogate mother for carrying the child, but expresses his concern in the child’s potential “urge to find or look for the surrogate mother.” Although they express sympathy with the surrogate mother parting with the child, their potential relationship is also pointed out as a major concern: “What if she [bothers us], or she wants to be involved in the child’s life for as long as the child lives?” (Tracy). Their concerns are very much similar to those of the Philippine online community, where the risk in the child’s future is considered to be a major concern (Pangalangan et al., 2017).
Split between surrogacy as a compassionate act or transactional business
The participants negotiated the idea of surrogacy in contrasting ways, mainly between it being a compassionate act or a transactional business, which had corresponding implications on their position and consideration of the matter. Participants had different perspectives, shifting between different stances when discussing the intentions, actions, and the outcomes of the significant parties.
On one hand, surrogacy was constructed as a life-giving process enabling infertile couples to have a child. Tracy described surrogate mothers as “selfless” because they “sacrifice nine months to carry someone else’s baby”, while Nadine expressed admiration for surrogate mothers because they are willing to “give up [their] own flesh and blood for other people”. In such cases, surrogate mothers are assumed to have agency in the process, utilizing their God-given “free will” (Nadine). Thus, the surrogate mother is portrayed in a positive light due to her intention to help. These descriptions effectively minimize the importance of monetary earnings (Pande, 2011) and highlight how the surrogate mother effectively fulfills the expectations of parenthood by offering couples the possibility of having their “own child” (Arvidsson et al., 2017).
On the other hand, surrogacy may be constructed as a commercially driven business, due to their intentions and actions carried out to achieve it. The word “pay” often came up when asked about their impressions of surrogacy, indicating its transactional nature. Josh points out its similarity to “prostitution” and “human trafficking” due to the monetary exchange involved in availing of it, suggesting its role in exploiting the women involved. The key players, namely the surrogacy agencies and the surrogate mothers, are also criticized by some of the participants because of how they commercialize the needs of couples. This is in line with the finding that surrogate mothers are framed in a negative light by the Philippine general public, who assume their intentions are merely commercial due to their perceived low socioeconomic background (Pangalangan et al., 2017).
Their unfavorable construction is reflected in their judgement toward the mother. Rachel shares her disapproval, saying “If it’s for her … to earn something…then I don’t think … it’s correct”. The word correct gives an absolute judgement on the woman’s decision, yet her hesitation in delivering the statement indicates this is not something she is willing to openly mention. Kath describes the surrogate mother as a person who is willing to reduce the child to nothing for monetary compensation: Of course it’s hard. Your kid, although it’s not your egg cell, and then the sperm cell. Because of course, it will be carried for 9 months. And then after that, will it be nothing? When you give birth, you’ll collect the money? I think – I don’t know. There are people like this? I don’t think I can handle it if it’s like that […] Of course, there was so much you went through, labor pain, everything. And then you’ll just give – well it’s not just giving it away, since you were in agreement. You need to be able to see it, since it’s like your child too.
However, the participants point out the arrangement set forth by the agencies may exploit the vulnerable parties, shifting the perspective on the mother. James claims surrogacy agencies are “just using [the surrogate mothers’] bodies for income.” To emphasize this point, Ross likened the surrogacy industry to a “meat shop” as he describes them as merely “selling” the child. Although the agencies’ altruistic intentions are sometimes recognized, with Kath suggesting “maybe they have reasons, a good purpose to help out” for couples who “don’t have any other choice except that”, they are often described in terms of their role as “middle-men”, highlighting their job in collecting fees to connect relevant parties, effectively placing these institutions in a negative light.
Discussing the issue in light of the exploitation lens also begs the question of the role of the potential parents in the matter, who may exploit the mother in availing of her services. James explains: “I’m treating her not as a human person, but as an end … I want to have a child through her. So. I think it’s not moral in a way.” He articulates the morality of the actions he would take, expressing hesitancy in availing of such services. The point is built upon by comparing the woman to objects, namely “containers” that merely hold the baby, and “towels” that are easily thrown away. This is similar to findings that agencies in the Philippines may view the mother merely as a “vessel” to protect a child (Pangalangan et al., 2017). Potential parents also recognize its consequences on the mother’s emotional well-being. Ted describes feeling “pity” for her, and attempts to sympathize by imagining the struggle of carrying the child and questions the psychological effects of having to give it away. Lia encapsulates the struggle in her statement: “You’re robbing herself of something. And you’re contributing to it.” In doing so, the potential parents recognize their unique position in possibly exploiting the mother in various respects (Sandoval, 2010; Vora, 2013).
James briefly touches on the largely unexplored phenomena of surrogacy in a developing country, beyond the one-way relationships often described in the literature on transnational surrogacy (Markens, 2012). He describes the unique dynamic taking place: We’re in a third world country. Joel Cruz, Vicky Belo … they are exempted from it because they are rich. They can afford [it]. But then you notice that they didn’t acquire women from the Philippines, apart from abroad. But Americans, or whoever they are, they acquire women from us. ’Cause it’s cheaper.
Ultimately, one’s construction of surrogacy as a money-making or gift-giving process seems to reflect their consideration of the option, with some establishing a clear difference between commercial surrogacy and altruistic surrogacy. Ross describes being more open to the arrangement if it takes the form of the latter, where a “good person willing to help you out” is involved. However, the difference between the two is not always evaluated positively or negatively. James acknowledges engaging in surrogacy is not “good” or “bad”, but merely a decision one willingly makes with its own repercussions, pushing forward the narrative of choice. Liza acknowledges both aspects; while it is a job wherein the surrogate mothers and surrogate agencies earn money, their purpose is still to help the infertile couples who are unable to produce a child of their own. From this perspective, surrogacy is ultimately defined by its outcomes, namely the act of birthing a child, beyond the objectives behind it. James talks about these implications: “They give people the opportunity to have kids. That’s one. I don’t see them as a bad person, I see them as a person trying to survive”. His statement acknowledges that people may engage in surrogacy merely to “survive”, pointing toward its businesslike features, which leads to the positive “opportunity” to have a child. This neutral stance is a reflection of their expressed ambivalence toward the process, without any personal investment in the process.
Negotiation of the role of religion
The strict stance of the Church against reproductive technologies was negotiated by the participants in various ways, where it was reframed, given less importance, or ignored in the discourses. The participants claimed their religious spirituality was important to them; they cited actively practicing their faith, which affected how they framed the ideas of fertility and conceiving. Lia cites the journey of fertility is “just between me, my husband, and God.” For some, religion acted as an anchor of hope in light of unsuccessful attempts at conception. Liza says, “[if] God is going to give it, He’ll give it. It’s like, [we’re] traditional as compared…for us, we pray for it.” Thus, should they still be unsuccessful, infertility is commonly cited as “God’s plan”, with James saying the next possible action is to “move on”.
Although the predominant conservative Catholic values are identified to limit discussions on surrogacy (Pangalangan et al., 2017), they do not entirely result in disagreement for it. On the topic of surrogacy, religion is negotiated wherein the Church is not given absolute authority on the matter. Instead, some argued their faith, which is not always tied to religion, was more meaningful to them. Nadine separates the idea of “God” from the Church’s stance, and assumes “God will understand even if the Church says ‘No!’ But God will be the one to decide in the future for us anyway.” However, when it was clarified, many still cited the Church’s teaching as a reason to decline surrogacy, supporting the finding that infertile individuals in many cultures affirm their religious beliefs when making decisions about surrogacy (Bello et al., 2014). Though the current study reveals this is not the most significant factor. Ross shares how religious thinking does not necessarily have to be applied when discussing issues of fertility: It’s not gonna be about religion. Um, if God wants it to be so, it’s gonna be … Um, religion [it] has nothing to do with how much you want kids. You pray for it … it comes to you in different ways. Um, it may not be coming to you directly, or on your path, it may be coming from a different path, but it’s coming for you, and for you alone. So yeah … I won’t, I won’t put religious thinking if I go for it or not.
Other factors are prioritized, relating to one’s own circumstances instead. Nadine argues one’s readiness to engage in the process, rather than faith, is a more important consideration, which takes account of her psychological and emotional state. Tracy outlined the relationship between faith and reason in making a decision on one’s reproductive health: I don’t want to seem [like] I’m following this blind religion [that when the] Church [says] no, no, [but] it’s more of [the] effect [of] medicines in the body, so more of that. Not, not [like, when they say you can’t eat] pork, [I’m not going to eat pork because the Church says so].
Others have expressed they found the Church’s stance on surrogacy ambiguous, leading them to create their own assumptions on what it would entail, so that it is still being considered. For instance, many attempted to negotiate their faith with their positive opinion on surrogacy. Ted justifies surrogacy as acceptable in terms of other Church teachings about life, rather than focusing on the unnatural way of conception that is usually the topic of debate, stating “I think it is accepted by the Church. And…It’s not like preventing someone from living like abortion, so it’s like it’s, it’s still giving someone life so, I have no problem with that.” Participants ultimately frame surrogacy as a means to fulfill God’s desire for children in a marriage (Ishak & Haneef, 2014), taking a “contextual approach” to the issue instead (Bautista, 2010).
All the discourses paint a picture of surrogacy in the Philippines, where it is viewed as a last choice, due in part to its limited accessibility to the general public, and the practical and emotional burdens that come with the involvement of another person. These give rise to ethical and religious concerns, which are negotiated by the participants to highlight or downplay these issues.
Theoretical and practical implications
The discursive analysis framework illustrated how infertile couples use language to actively construct the controversial topic of surrogacy, resulting from the relatively limited discursive resources to bring about certain effects in the discussions (Potter & Wetherell, 1987). The discussions were influenced by their selective attention toward particular instances to forward the choice versus exploitation narrative (Markens, 2012), particularly shaping how surrogacy is viewed as a compassionate act or transactional business (Millbank, 2012). The results support the feminist literature by providing frames of reference of the potential mothers, in which their role is compromised due to the nature of the process, and the ways potential couples frame the surrogate mother based on their view of the process (Majumdar, 2014). It also touches on the postcolonial aspects of surrogacy (Lau, 2018) from a developing country’s perspective by recognizing how differences in socioeconomic status serve as a critical factor in how surrogacy is carried out in the country.
The current study also holds practical implications on the practice of surrogacy. The study attempts to supplement the body of knowledge by looking at a relatively unexamined sample, since the commissioning parents have more often been studied. It provides a unique perspective on surrogacy among those who may potentially avail of it from a third-world country by examining the potential influences of socioeconomic status and religion, highlighting the role of the former and downplaying the role of the latter. Moreover, it explores the gap between the prevalence of surrogacy and the couple’s decision to avail of it, which were found to be informed primarily by the media. It confirms there is limited information available from credible sources; if surrogacy is to be considered a viable option, hospitals and agencies should be able to provide comprehensive information about what it entails to interested parties, while navigating the country’s context. The findings of the study can also guide provisions and legislations to address the interests of the potential parents and other involved parties.
Limitations and recommendations
A potential limitation was the inclusion of a definition on surrogacy in the interview schedule, a decision the researchers made with the expectation that not everybody was familiar with the method in question. Future studies could delve deeper into the discourses of each participant with their own constructions on surrogacy without additional input for data to more accurately reflect the discourses should they exist in reality. The interviews also did not further expound on the differences between local and transnational surrogacy arrangements, which was only explicitly brought up by one participant. It would be worth clearly distinguishing which option participants construct, and how they may frame both cases differently. Emphasizing this aspect would shed light on the dynamics on surrogacy from a Philippine perspective, as a provider of surrogacy around the world.
The researchers believe that the findings of this study are open to transferability, which is depicted in its ability to advance theoretical understandings relevant to multiple situations (Kuper, Lingard, & Levinson, 2008), particularly regarding the discourses on reproductive health concerns among Filipinos. For future studies, it is suggested public discourses on surrogacy be systematically examined among different groups. In doing so, further studies can explore the effects of age, gender, socioeconomic status, and religion on surrogacy, given findings these may influence one’s stance.
Conclusion
The current study examined the varied discourses on surrogacy to shed light on the gap between the limited discussion on surrogacy among infertile couples and the prevalence of the method in the Philippines. The findings reflect the discourses resulting from the relatively narrow discursive resources of potential parents, which suggest potential parents do not construct this option as a viable alternative. These discourses involve the negotiation of key concerns, such as emotional and ethical matters, which present a need to address these issues to enable informed decision-making. Surrogacy agencies, medical practitioners, and government agencies can take these discourses into consideration through the ways they frame surrogacy and create appropriate policies about it. All of this can help in contextualizing surrogacy in the Philippines as it continues to be practiced as a critical player in both providing and availing of the service, both within the country and in the world at large.
Footnotes
Authors’ note
All authors are affiliated with the Department of Psychology, Ateneo de Manila University, Quezon City.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.